The ability for nurses to provide advanced nursing care has a long and interesting history. Starting in 1965 – the foundation of the Nurse Practitioner movement – states began to formally recognize and authorize nurses to provide care traditionally offered by physicians. As the advanced practice role and scope of practice evolved, so did the requirements to practice, seen in the shift from certificate programs to master’s degree programs.
Today, we are witnessing a similar shift in what it should take to provide advanced nursing care.
The Doctor of Nursing Practice (DNP) builds on the foundation of a master’s-level education. It demonstrates our professional commitment to the highest level of knowledge in the discipline for the highest level of patient care.
The ever-changing landscape of health care requires Advanced Practice Registered Nurses (APRNs) to not only have expert clinical knowledge in evidence-based practice, but also leadership skills, and an understanding of quality improvement, clinical analytics, and population health to prioritize and problem-solve patient care on a broader scale.
Patient Care is Rapidly Becoming a ‘Team Sport’
Due to many factors, including increasing costs and physician specialization, more and more healthcare organizations are adopting innovative approaches to patient care that bring together professionals across the healthcare team.
One such model is highlighted in a feature in Politico titled “The doctor of the future.” The University of Colorado-affiliated health system UCHealth is creating clinics around the concept of team-based care. Care is provided based on expertise – whether that be medical, pharmacy, mental health, nutrition, social work, or nursing – and shared responsibility is integrated across the clinic, even in the building layout; examination rooms surround a shared desk space in one such clinic.
As resources become more strained, APRNs will be tasked with more responsibilities that were previously handled by physicians. In other words, we will continue to gain more practice authority. But that does not come without a cost.
The increasing complexity of managing patient care in a health care system may create a situation where some master’s-prepared APRNs are not fully capable of fulfilling their newfound responsibilities. A doctoral education expands practice knowledge into analytical knowledge that inspires the inquisitive APRN to assess, implement, and evaluate innovative ways to improve patient care and quality of care. It also prepares the APRN for responsibilities beyond patient care.
APRNs Provide More Than Patient Care
As Dr. Jacquelin Corley, a neurological surgery resident at Duke University Medical Center points out, APRNs (and our Physician Assistant [PA] colleagues) have a larger role than direct patient care. She argues that APRNs and PAs “are fundamental to medical education, mentoring, clinical and basic science research, and they are important advocates for many different patient populations.”
A DNP education expands on the core competencies of advanced practice nursing learned at the master’s level. This includes greater leadership and mentorship skills, but also the ability to implement up-to-date research into practice and investigate innovative ways to impact healthcare at the highest level of patient care. This level of preparation demonstrates to our fellow interdisciplinary colleagues that we are a mature and capable profession, which is important as we press towards full practice authority across the nation.
Fellow Health Professions are Moving Toward Doctoral Education
Advanced practice nursing is not alone in transitioning to a professional doctorate. In recent years, several health professions now require, or will soon require, a doctorate to enter practice, including pharmacy (2000), audiology (2012), physical therapy (2017), and occupational therapy (2027).
This cross-disciplinary movement toward doctoral education is inspired by many of the same reasons identified by the American Association of Colleges of Nursing (AACN) in their 2004 position statement on establishing the practice doctorate in nursing, namely “[t]he growing complexity of health care, burgeoning growth in scientific knowledge, and increasing sophistication of technology.”
Much has changed in healthcare since 2004, but this statement is truer than ever before. Given our unique responsibility over the health and welfare of our patients, it is our professional duty to develop advanced competencies beyond what we learned at the master’s-level.
Patients recognize and appreciate the high-level quality care provided by APRNs. We are in a unique situation to accelerate our contributions for improving quality of care in the health care arena and strengthening our roles in patient care within the health care team.
The ‘call to action’ is for nurses to “practice to the full extent of their education and training.” It is our turn to elevate the nursing profession, meeting other health professions in the transition to practice doctorates. We are responsible as APRNs to practice within our scope of practice and provide the highest level of patient care. This ‘call’ requires skills, such as creative and systematic thinking, problem solving, leadership, and research translation, all of which are cultivated in a DNP program.
